S5 E5: Interview with Prof Hazel Everitt - amitriptyline for IBS; methotrexate for hand OA; leaflets for LUTs
Dec 1, 2023
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Prof. Hazel Everitt, a GP and lead author on a significant study regarding amitriptyline for IBS, joins the discussion. She shares insights into how low-dose amitriptyline can effectively manage IBS symptoms. The conversation also dives into the controversial use of methotrexate for hand osteoarthritis, revealing the complexities of pain management. Additionally, they explore a patient information leaflet aimed at alleviating lower urinary tract symptoms and whether such resources can be more beneficial than traditional medications. Empowering patients remains a key focus.
Amitriptyline has shown significant effectiveness in improving IBS symptoms and may be considered a viable second-line treatment option.
Research on methotrexate suggests it offers moderate pain relief for hand osteoarthritis, emphasizing the need for further long-term studies.
Deep dives
The Impact of Amitriptyline on Irritable Bowel Syndrome
Research indicates that amitriptyline can significantly improve symptoms associated with irritable bowel syndrome (IBS). A large randomized controlled trial demonstrated that low doses of the medication led to better outcomes compared to a placebo. Participants noted improvements in IBS symptoms, suggesting that amitriptyline functions primarily as a neuromodulator rather than an antidepressant. The findings advocate for considering amitriptyline as a second-line treatment option for patients who do not respond to first-line therapies.
Addressing Hand Osteoarthritis with Methotrexate
The role of methotrexate in treating hand osteoarthritis, particularly cases with synovitis, is explored through research indicating a moderately beneficial effect. A clinical trial focused on patients suffering from hand osteoarthritis demonstrated that those receiving methotrexate reported lower pain levels over time compared to those on placebo. Although the difference in pain scores was modest, the findings suggest that methotrexate could be a useful option for inflammatory subtypes of hand osteoarthritis. Researchers urge further investigation into long-term benefits and effects on disease progression before definitive conclusions can be reached.
Improving Lower Urinary Tract Symptoms in Men
Research into managing lower urinary tract symptoms in men has emphasized the effectiveness of a well-designed patient information leaflet. This study confirmed that providing clear, practical guidance significantly improved symptoms when compared to standard care. Although the resulting improvement was less than anticipated, the findings underscore the value of incorporating educational resources into patient care strategies. The authors of the study advocate integrating this patient-focused approach into general practice to facilitate better management of urinary symptoms.
Continuity of Care in General Practice
A recent report calls for continuity of care in general practice, highlighting its crucial role in timely diagnosis and patient safety. Evidence from case studies suggests that lack of consistent care contributes to delayed diagnoses, which can significantly affect patient outcomes. The report proposes modifications to the GP contract to support continuity and encourage practices to operate within defined hours, fostering a stable working environment for clinicians. Greater commitment to continuity is seen as essential for addressing the complexities faced by GPs today while improving overall patient care.
Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. In this episode, we talk to Prof Hazel Everitt, a GP and lead author of a recent Lancet paper exploring whether amitriptyline is effective for IBS, and where it might fit in to general practice management.
We also look at research in the Lancet on treating hand osteoarthritis with methotrexate - what's the rationale and does it work? - plus a BMJ paper on using a patient information leaflet to improve lower urinary tract symptoms in men. Are PILS better than pills?